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N
D
&
a
e
L
|
e
5
Form 1045
L
Rev. Nov. 1941
P
AMERICAN RED CROSS
40 -
a
0
NURSING SERVICE
a
Name in full Davenport , havenia Irene
Tel. No. Wo 5857
+
(last)
(first)
(middle)
If married, give maiden name
Best, hi venia
Year of birth 1894
M
Marital status
married
Husband's
name Dayenpont , Poyal W.
1
(single, married, widowed, divorced)
S
Permanent address 64 28 31st St nw.
H. 6
(street)
(city)
(county)
(state)
Probable address
F bore
L
for the next year
(street)
(city)
(county)
(state)
a
Give name and address of nearest relative or friend in United States:
<
Haren port, R.W. Husband
n.w.
(b
(name)
(relationship)
(address)
5
Are you employed in nursing at the present time? Yes
No
PRESENT EMPLOYMENT (check below) Name of agency or institution with which employed
a
Institutional
Public health
H
Industrial
C
Private duty
Other (write in)
Government Service:
Army, Regular
Navy, Regular
Veterans Administration
Reserve
Reserve
Children's Bureau
U.S.P.H. Service
U.S. Indian Service
-
MAJOR RESPONSIBILITIES
Administration
Teaching
Private duty
of present employment
Supervision
General Staff
Other (specify)
How many years did you attend HIGH SCHOOL?
One
Two
Three
Four
Graduated
Yes
No
SINCE GRADUATION FROM YOUR SCHOOL OF NURSING
have you ever had-
1. A postgraduate course or experience in any of the following special services?
Postgraduate course
Experience in hospital
in a hospital
or public health field
(at least 3 months)
(at least 6 months)
Communicable disease nursing (include Tbc)
Psychiatric Nursing
Operating room
Anaesthesia
Public health 'nursing
2. Have you taken any courses in a college or university?
Less than
One
Two
Three
Four
Bachelor's
Master's
P.H.D.
Certificate in
*one year
year
years
years
years
degree
degree
degree
Public Health
X
In what major field was above study? Health Education
What languages, other than English, do you speak?
215142
* Academic year
(OVER)
Page data
- Page
- 21
- Source index
- 0
- Type
- photo
- Media ID
- a214acdd930042ec
- Size
- unknown
Document data
- ID
- 2661314
- Core
- doc
- Type
- document
DTO data
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Context sent to Scholar
Document identity
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Document source extras
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Page context
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"ocrText": "N\nD\n&\na\ne\nL\n|\ne\n5\nForm 1045\nL\nRev. Nov. 1941\nP\nAMERICAN RED CROSS\n40 -\na\n0\nNURSING SERVICE\na\nName in full Davenport , havenia Irene\nTel. No. Wo 5857\n+\n(last)\n(first)\n(middle)\nIf married, give maiden name\nBest, hi venia\nYear of birth 1894\nM\nMarital status\nmarried\nHusband's\nname Dayenpont , Poyal W.\n1\n(single, married, widowed, divorced)\nS\nPermanent address 64 28 31st St nw.\nH. 6\n(street)\n(city)\n(county)\n(state)\nProbable address\nF bore\nL\nfor the next year\n(street)\n(city)\n(county)\n(state)\na\nGive name and address of nearest relative or friend in United States:\n<\nHaren port, R.W. Husband\nn.w.\n(b\n(name)\n(relationship)\n(address)\n5\nAre you employed in nursing at the present time? Yes\nNo\nPRESENT EMPLOYMENT (check below) Name of agency or institution with which employed\na\nInstitutional\nPublic health\nH\nIndustrial\nC\nPrivate duty\nOther (write in)\nGovernment Service:\nArmy, Regular\nNavy, Regular\nVeterans Administration\nReserve\nReserve\nChildren's Bureau\nU.S.P.H. Service\nU.S. Indian Service\n-\nMAJOR RESPONSIBILITIES\nAdministration\nTeaching\nPrivate duty\nof present employment\nSupervision\nGeneral Staff\nOther (specify)\nHow many years did you attend HIGH SCHOOL?\nOne\nTwo\nThree\nFour\nGraduated\nYes\nNo\nSINCE GRADUATION FROM YOUR SCHOOL OF NURSING\nhave you ever had-\n1. A postgraduate course or experience in any of the following special services?\nPostgraduate course\nExperience in hospital\nin a hospital\nor public health field\n(at least 3 months)\n(at least 6 months)\nCommunicable disease nursing (include Tbc)\nPsychiatric Nursing\nOperating room\nAnaesthesia\nPublic health 'nursing\n2. Have you taken any courses in a college or university?\nLess than\nOne\nTwo\nThree\nFour\nBachelor's\nMaster's\nP.H.D.\nCertificate in\n*one year\nyear\nyears\nyears\nyears\ndegree\ndegree\ndegree\nPublic Health\nX\nIn what major field was above study? Health Education\nWhat languages, other than English, do you speak?\n215142\n* Academic year\n(OVER)"
}